AMIA pointed out that substantial variation still exists across health IT standards and implementation methods despite the known importance of standardization in enabling true interoperability and facilitating seamless health data exchange.

Dig Deeper

“There is also a gap in defining clinical standards that can be used interchangeably with basic research standards, limiting translational use of research discoveries,” wrote AMIA.

In an effort to resolve some of these problems, AMIA first recommended ONC update its 2015 Nationwide Interoperability Roadmap. The roadmap addresses areas of interoperability including health IT certification, health IT testing, and standardization.

AMIA suggested ONC update the roadmap by including the following:

A detailed gap analysis of current and needed standards to address priority national use cases.

An update to and articulation of how ONC will achieve an Industry-wide Testing and Certification Infrastructure.

A description of how federal investments are coordinated to make progress on the standards-related aspects of the Nationwide Interoperability Roadmap.

AMIA recommended ONC create a supplemental roadmap dedicated only to standards and the relationship between standards. The standards roadmap would also address which standards are phasing out of use and where the industry is headed in terms of developing new ones.

As part of the standards roadmap, AMIA suggested ONC identify use cases for existing and necessary standards.

“ONC should convene and coordinate discussions that identify important use cases to identify what standards are needed and in what combination to ensure interoperability,” the association maintained.

AMIA also recommended ONC improve standards testing and test tooling.

“Thorough testing remains an unrealized aspect of our nationwide approach to standards,” stated AMIA. “Very few standards undergo rigorous testing at the development-level or at the implementation-level. Both are critical if interoperability is to occur.”

AMIA further suggested that the ONC Health IT Certification Program testing is insufficient for enabling interoperability as it tests conformance rather than true interoperability, which would focus on the sending and receiving of information.

Several organizations have taken issue with the health IT certification program, prompting ONC to implement a five-year plan intended to make changes. However, forthcoming changes to the health IT certification program will center on encouraging the use of privately-developed testing tools rather than reconfiguring program test objectives.

“As a foundational principle, AMIA believes that health IT interoperability provides an enormous positive impact on society,” the association stated. “Thus, AMIA recommends adequate funding for the development, management, testing, and maintenance of HIT standards, as well as the standards development organizations that create them.”

Investments should go toward terminologies and reference standards that may be used together. AMIA suggested these investments could come from the 21st Century Cures mandate to develop an EHR Reporting Program or other initiatives.

“Another option would be to coordinate across federal agencies and offices that rely on or reference health IT standards,” the association continued. “Regardless, sufficient and sustained investment by the federal government is necessary for interoperability to be achieved nationwide.”

The 2018 ISA reference edition will include a new section about administrative standards and implementation specifics, as well as educational and informational resources to allow for better understanding of interoperability concepts.